Endoscopic retreatment of Zenker's diverticulum using novel endoscopic scissors - The Clutch Cutter device.

Treatment of Zenker's diverticulum by flexible endoscopy consists of the myotomy of the cricopharyngeal muscle and is considered to be feasible, effective and safe. This report describes the novel use of a Clutch Cutter® device to perform flexible endoscopic retreatment of a symptomatic recurrence after previous treatment using a Needle knife in a 68 year old woman with symptoms of dysphagia for solids.

[High-grade dysplasia as a result of gastric metaplasia]. / Displasia de alto grado como resultante de metaplasia gástrica.

Barrett's esophagus (BE) is an acquired condition in which the normal esophageal squamous epithelium is replaced by columnar epithelium. It has been long pointed out that columnar metaplasia should be of intestinal goblet cells in order to define the BE, because intestinal metaplasia (IM) has been considered as the only conferring oncogenic risk, therefore having pre-neoplastic potential However, the definition ofBE restricted to the presence of IM has been widely discussed and currently constitutes a debated topic. We describe the case ofa patient with gastroesophageal reflux disease and high-grade dysplasia in the distal esophagus. Endoscopic mucosal resection ofthe lesion was performed using the Duette technique in one piece. The pathological study reported high-grade dysplasia with morphological features consistent with gastric metaplasia, without IM. The patient was treated with a proton pump inhibitor (PPI) and developed a disseminated dermatosis. He was evaluated by a dermatologist who diagnosed lichenoid dermatitis probably due to the PPI. The PPI was replaced by a H2 inhibitor and the skin lesions improved. The endoscopic control showed no residual tissue in the site of resection and the biopsies of the scar were negative for dysplasia and gastric metaplasia.

Gastric endoscopic submucosal dissection: from animal model to patient.

AIM: To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection (ESD), thus contributing to its subsequent application in human patients. METHODS: This study/learning process was carried out in 3 phases: Phase I: Ex vivo animal; Phase II: In vivo animal; Phase III: Humans. One endoscopist performed 30 gastric ESDs in porcine models, and later 5 gastric ESDs in 5 patients. The ESD was done following the method practiced at the National Cancer Center in Tokyo, Japan. Technical aspects, size, time and speed of ESD, as well as complications were registered. In patients, their clinical, endoscopic and histologic evolution was additionally added. RESULTS: Thirty en bloc ESDs were carried out in animal models. The mean ± SD size of the pieces was of 28.4 ± 1.2 mm, and the time of ESD was 41.7 ± 2.4 min. The time of ESD in the first 15 procedures was 43.0 ± 3.0 min whereas in the next 15 procedures, the time was 40.3 ± 3.9 min, P = 0.588. The speed in the first 15 ESDs was 1.25 ± 0.11 cm(2)/min vs 2.12 ± 0.36 cm(2)/min in the remaining 15, P = 0.028. There were no complications. In patients, 5 lesions were resected en bloc. The size of the pieces was 25.2 ± 5.1 mm and the time was 85.0 ± 25.6 min. Endoscopic and histological controls did not show evidence of residual neoplastic tissue. CONCLUSION: A sequential ESD training program of a unique endoscopist, based on the practice in porcine models, contributed to learning ESD for its subsequent application in humans, yielding good results in efficacy and safety.

Endoscopic retreatment of Zenker’s diverticulum using novel endoscopic scissors - The Clutch Cutter device

No disponible